Stem cell therapy for Hirschprung disease

Boala Hirschsprung (HSCR) este o anomalie congenitală a colonului care rezultă din eșecul formării sistemului nervos enteric, care duce la un segment disfuncțional îngustat al colonului cu lungimi variabile și care necesită intervenție chirurgicală. Fiziopatologia de bază include un defect în migrarea, proliferarea și diferențierea celulelor crestei neurale, parțial explicate prin modificări genetice și epigenetice identificate. În ciuda ratei ridicate de succes a intervențiilor chirurgicale curative, acestea sunt asociate cu rezultate adverse semnificative, precum enterocolita, incontinența fecală și constipația cronică. În plus, unii pacienți suferă de variante letale extinse ale bolii, toate acestea justificând necesitatea unui tratament alternativ. În ultimii 5 ani, s-au înregistrat progrese considerabile în cercetarea terapiei bazate pe celule stem a HSCR. Cu toate acestea, multe probleme importante rămân nerezolvate. Această revizuire va oferi informații generale concise despre HSCR, va sublinia viitoarele abordări ale terapiei pe bază de celule stem a HSCR, va revizui publicațiile cheie recente, va discuta provocările tehnice și etice cu care se confruntă domeniul înainte de interpretarea clinică și va aborda aceste provocări propunând soluții și evaluând abordările existente pentru a progresa în continuare.Hirschsprung disease (HSCR) is a congenital anomaly of the colon that results from failure of enteric nervous system formation, leading to a constricted dysfunctional segment of the colon with variable lengths, and necessitating surgical intervention. The underlying pathophysiology includes a defect in neural crest cells migration, proliferation and differentiation, which are partially explained by identified genetic and epigenetic alterations. Despite the high success rate of the curative surgeries, they are associated with significant adverse outcomes such as enterocolitis, fecal soiling, and chronic constipation. In addition, some patients suffer from extensive lethal variants of the disease, all of which justify the need for an alternative cure. During the last 5 years, there has been considerable progress in HSCR stem cell-based therapy research. However, many major issues remain unsolved. This review will provide concise background information on HSCR, outline the future approaches of stem cell-based HSCR therapy, review recent key publications, discuss technical and ethical challenges the field faces prior to clinical translation, and tackle such challenges by proposing solutions and evaluating existing approaches to progress further

Advances and innovations in thoracic esophageal cancer surgery

Cancerul esofagian este o afecțiune malignă agresivă cu o incidență în continuă creștere și un prognostic nefavorabil. Tratamentul cancerului esofagian a devenit mai eficient in prezent prin abordarea multidisciplinară și prin crearea unor centre de excelență cu un volum mare de patologie esofagiană. Progresele în stadializare, tehnologia chirurgicală, terapia neoadjuvantă și îngrijirea perioperatorie au determinat reducerea morbidității și a mortalității. Principiul de bază actual al tratamentului curativ pentru boala localizată este intervenția chirurgicală, asociată cu radi-ochimioterapia neoadjuvantă pentru stadiile avansate local. Pentru a reduce morbiditatea postoper-atorie, au fost introduse în urmă cu 32 de ani, în arsenalul terapeutic al cancerului esofagian și tehnicile chirurgicale minim invazive. Există însă controverse legate de utilizarea abordului min-im invaziv în practică deoarece necesită o bază tehnică pretențioasă și dificil de accesat, o tehnică operatorie laborioasă și are o curbă lungă de învățare. Utilizarea tehnicilor chirurgicale minim invazive în tratamentul cancerului esofagian toracic, a avut totuși un impact important asupra morbidității și mortalității post-esofagectomie.Esophageal cancer is an aggressive malignancy with an increasing incidence and an unfavorable prognosis. The treatment of esophageal cancer has become more effective nowadays through the multidisciplinary approach and the creation of centers of excellence with a large volume of esoph-ageal pathology. Advances in staging, surgical technology, neoadjuvant therapy, and perioperative care have reduced morbidity and mortality. The current basic principle of curative treatment for localized disease is surgery, associated with neoadjuvant chemoradiotherapy for locally advanced stages. To reduce postoperative morbidity, minimally invasive surgical techniques and surgical techniques were introduced 32 years ago in the therapeutic arsenal of esophageal cancer. However, there is controversy about the use of the minimally invasive approach in practice because it re-quires a demanding and difficult to access technical basis, a laborious surgical technique and a long learning curve. The use of minimally invasive surgical techniques in the treatment of thoracic esophageal cancer, however, had a significant impact on post-esophagectomy morbidity and mortality

Mature Teratoma Associated with Bilateral Ovarian Carcinosarcoma -Accidental Association or Etiopathogenetic Determinism? -Case Report

Rezumat Teratom matur ovarian bilateral asociat cu carcinosarcom -asociere întâmplãtoare sau determinism etiopatogenic? -prezentare de caz Carcinosarcomul este o forma rarã de cancer ovarian cu origine mixtã, iar asocierea sa cu teratomul matur este extrem de rarã. Prezentãm cazul pacientei T.M. în vârstã de 67 ani, internatã în clinicã în 15.05.2016, F.O. 4877 pentru creaeterea în volum a abdomenului. La internare, pacienta afebrilã, conaetientã, cooperantã, echilibratã cardio-respirator, cu abdomen destins de volum, matitate accentuatã pe flancuri, semnul valului pozitiv, bioumoral în limite normale cu excepåia: acid uric seric = 6.64 mg/dl, glicemie sericã = 113.7 mg/dl, proteine serice totale = 8.65 g/dl, raportul albuminã/globulinã subunitar, CRP 33.63 mg/l, sideremie 51 ug/dl, CA 125 = 588.4 UI. Ecografia abdominalã: cantitate mare de lichid decliv aei perihepatic aei multiple formaåiuni tumorale cu transformare chisticã la nivelul abdomenului aei pelvisului. Examen CT descrie multiple mase tisulare localizate intraperitoneal abdomino-pelvin, manaeonate în epanaeament lichidian, infiltrative, cu efect de masã pe lumenele digestive, fãrã obstrucåie vizibilã CT. Tratamentul chirurgical a constat în evacuarea lichidului de ascitã, excizia formaåiunilor tumorale din marele epiploon, a formaåiunilor tumorale din ligamentul gastro-colic, epiploonectomie, anexectomie bilateralã aei histerectomie totalã. Evoluåie postoperatorie simplã. Examenul histopatologic confirmã diagnosticul de carcinosarcom ovarian bilateral asociat cu teratom matur tridermic (prezenåa zonelor de åesut cerebral, asociat cu åesut cartilaginos, epiteliu de tip tranziåional, epiteliu de tip tubar, stromã de tip endometrial, åesut adipos). IHC confirmã compatibilitatea cu diagnosticul de carcinosarcom ovarian (tumorã malignã mixtã mullerianã). Pacienta a urmat polichimioterapie adjuvantã. Asocierea teratomului cu elemente carcinosarcomatoase conferã cazului un prognostic infaust. Cuvinte cheie: teratom matur, carcinosarcom ovarian Abstract Carcinosarcoma is a rare form of ovarian cancer with mixed origin, and its association with mature teratoma is extremely rare. We present the case of patient T. M. aged 67, admitted into our clinic on the 15/05/2016, F.O. 4877 for the increase of the abdominal volume. On admission, the patient was afebrile, conscious, cooperative, cardio-respiratory balanced, having the abdomen distended in volume, sharp dullness in the flanks, positive wave sign bioumoral within normal limits except: uric acid = 6.64 mg / dL, serum glucose = 113.7 mg / dl, serum total proteins = 8.65 g / dl, the albumin / globulin subunit, CRP 33.63 mg / l, sideremia 51 ug / dl, CA 125 = 588.4 IU. Abdominal ultrasound: high volume fluid and multiple perihepatic formations and multiple formations with cystic Chirurgia (2016) 111: 422-427 No. 5, September -October Copyright© Celsiu

The minimally invasive approach to adenocarcinoma of the esophagogastric junction - the experience of the Sf Maria General and Esophageal Surgery Clinic

Chirurgia minim invazivă este din ce în ce mai indicată în patologia oncologică. Deși esofagectomia este o operație dificilă cu o curbă lungă de învățare, există de fapt o deplasare către abordarea laparoscopică/toracoscopică/robotică datorită avantajelor vizualizării, confortului chirurgului (chirurgie robotică) și posibilității întregii echipe de a vedea operația in acelasi fel ca si chirurgul operator. Deși în prezent există încă multe subiecte controversate despre tratamentul chirurgical al pacienților cu adenocarcinom al joncțiunii esogastrice, cum ar fi tipul de abord chirurgical deschis sau minim invaziv, tipul de rezecție esogastrică, tipul de limfodisecție și altele, abordul minim invaziv s-a dovedit o modalitate de reducere a complicațiilor postoperatorii ale esofagectomiei, în special a complicațiilor pulmonare. Implementarea noilor tehnologii a permis lărgirea gamei de indicații pentru acest tip de abord chirurgical. Rezultatele obtinute imediat si la distanta, precum beneficiile pentru pacient - agresivitate chirurgicala redusa, recuperare rapida si nu in ultimul rand beneficiul estetic, ofera acestui tip de tratament chirurgical premisele dezvoltarii viitoare. Aceasta prezentare trece în revistă experienta Clinicii de Chirurgie Generala si Esofagiana Sf Maria privind abordarea minim invazivă pentru adenocarcinomul joncțiunii esofago-gastrice.Minimally invasive surgery is increasingly indicated in oncological pathology. Although esophagectomy is a difficult operation with a long learning curve, there is actually a shift towards the laparoscopic/thoracoscopic/robotic approach due to the advantages of visualization, surgeon comfort (robotic surgery) and the possibility of the whole team to see the operation as well as and the operating surgeon. Although currently there are still many controversial topics about the surgical treatment of patients with esophagogastric junction adenocarcinoma, such as the type of open or minimally invasive surgical approach, the type of esogastric resection, the type of lymph node dissection and others, the minimally invasive approach has proven to be a way to reduce postoperative complications of esophagectomy, especially by reducing pulmonary complications. The implementation of new technologies allowed the widening of the range of indications for this type of surgical approach. The results obtained immediately and at a distance, as well as the benefits for the patient - reduced surgical aggression, quick recovery and last but not least the aesthetic benefit, offer this type of surgical treatment the premises for future development. This presentation reviews the experience of the General Surgery and Esophageal Clinic of Sf Maria regarding the minimally invasive approach for esophagogastric junction adenocarcinoma

High-Sensitivity H₂ and CH₄ SAW Sensors with Carbon Nanowalls and Improvement in Their Performance after Plasma Treatment

We have developed surface acoustic wave (SAW) sensors with high sensitivity and a reversible response at room temperature (RT). The sensitive area of the sensor was prepared from vertically aligned graphene sheets, like carbon nanowalls (CNWs), which were deposited onto the quartz SAW sensor substrate. The CNWs were obtained by RF plasma-enhanced chemical vapor deposition (PECVD) at 600 °C, and their sensitivity was subsequently enhanced through hydrogen plasma treatment. The SAW sensors were tested at H2 and CH4 at RT, and they exhibited a reversible response for both gases at concentrations between 0.02% and 0.1%, with a detection limit of a few ppm. The additional hydrogen plasma treatment preserved the lamellar structure, with slight modifications to the morphology of CNW edges, as observed by scanning electron microscopy (SEM). X-ray photoelectron spectroscopy (XPS) investigations revealed the presence of new functional groups, a significant number of defects and electron transitions after the treatment. Changes in the chemical state on the CNW surface are most probably responsible for the improved gas adsorption after plasma treatment. These results identify CNWs as a promising material for designing new SAW sensors, with the possibility of using plasma treatments to enhance the detection limit below the ppm level

Laparoscopic Esocardiomyotomy—Risk Factors and Implications of Intraoperative Mucosal Perforation

Background: Mucosal perforation during laparoscopic esocardiomyotomy is quite frequent, and its consequences cannot always be neglected. The purpose of the study is to investigate the risk factors for intraoperative mucosal perforation and its implications on the postoperative outcomes and the functional results three months postoperatively. Material and methods: We retrospectively identified the patients with laparoscopic esocardiomyotomy performed at Sf. Maria Hospital Bucharest, in the period between January 2017–January 2022 and collected the data (preoperative—clinic, manometric and imaging, intra-and postoperative). To identify the risk factors for mucosal perforations, we used logistic regression analysis. Results: We included 60 patients; intraoperative mucosal perforation occurred in 8.33% of patients. The risk factors were: the presence of tertiary contractions (OR = 14.00, 95%CI = [1.23, 158.84], p = 0.033206), the number of propagated waves ≤6 (OR = 14.50), 95%CI = [1.18, 153.33], p p p p < 0.05). Conclusions: Identifying risk factors for this adverse intraoperative event may decrease the incidence and make this surgery safer. Although mucosal perforation resulted in prolonged hospital stays, it did not lead to significant differences in functional outcomes

The Use of Esophageal Stents in the Management of Postoperative Fistulas—Current Status, Clinical Outcomes and Perspectives—Review

Esophageal fistula remains one of the main postoperative complications, with the treatment often requiring the use of stents. This article reviews the updates on the use of endoscopic stents for the treatment of postoperative esophageal leakage in terms of indications, types of stents used, efficiency, specific complications and perspectives. Materials and Methods: We searched the PubMed and MEDLINE databases for the keywords postoperative esophageal anastomotic leak and postoperative esophageal anastomotic leak stent, and retrieved relevant papers published until December 2022. Results: The endoscopic discovery of the fistula is usually followed by the insertion of a fully covered esophageal stent. It has an efficiency of more than 60% in closing the fistula, and the failure is related to the delayed application of the method, a situation more suitable for endo vac therapy. The most common complication is migration, but life-threatening complications have also been described. The combination of the advantages of endoscopic stents and vacuum therapy is probably found in the emerging VACstent procedure. Conclusions: Although the competing approaches give promising results, this method has a well-defined place in the treatment of esophageal fistulas, and it is probably necessary to refine the indications for each individual procedure

Laparoscopic Esocardiomyotomy&mdash;Risk Factors and Implications of Intraoperative Mucosal Perforation

Background: Mucosal perforation during laparoscopic esocardiomyotomy is quite frequent, and its consequences cannot always be neglected. The purpose of the study is to investigate the risk factors for intraoperative mucosal perforation and its implications on the postoperative outcomes and the functional results three months postoperatively. Material and methods: We retrospectively identified the patients with laparoscopic esocardiomyotomy performed at Sf. Maria Hospital Bucharest, in the period between January 2017&ndash;January 2022 and collected the data (preoperative&mdash;clinic, manometric and imaging, intra-and postoperative). To identify the risk factors for mucosal perforations, we used logistic regression analysis. Results: We included 60 patients; intraoperative mucosal perforation occurred in 8.33% of patients. The risk factors were: the presence of tertiary contractions (OR = 14.00, 95%CI = [1.23, 158.84], p = 0. 033206), the number of propagated waves &le;6 (OR = 14.50), 95%CI = [1.18, 153.33], p &lt; 0.05), the length of esophageal myotomy (OR = 1.74, 95%CI = [1.04, 2.89] p &lt; 0.05), the length of esocardiomyotomy (OR = 1.74, 95%CI = [1.04, 2.89] p &lt; 0.05), and a protective factor&mdash;the intraoperative upper endoscopy (OR = 0.037, 95%CI = [0.003, 0.382] p &lt; 0.05). Conclusions: Identifying risk factors for this adverse intraoperative event may decrease the incidence and make this surgery safer. Although mucosal perforation resulted in prolonged hospital stays, it did not lead to significant differences in functional outcomes

The Influence of the COVID-19 Pandemic on Mortality of Patients Hospitalized in Surgical Services in Romania: A Cross-Sectional Study of a National Survey

Surgical practice worldwide has changed rapidly in response to the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to analyze the impact of the COVID-19 pandemic on mortality, in hospitalized patients, in Romanian surgical services. We have developed our research on a national survey of the consecutive records of hospitalizations, surgical interventions and deaths performed in Romania between March and August 2020. Results show that 47 surgical departments responded to the request. The admissions in the period March&ndash;August 2020 represented 52% of that from the similar period of 2019. In the studied period, the share of surgical interventions in patients admitted to non-COVID-19 centres was 98.7%, respectively 78.2% in COVID-19 support hospitals (p &lt; 0.05), and emergency interventions of 43.4% in non-COVID-19 hospitals, respectively 84.8% in COVID-19 support hospitals (p &lt; 0.05). Overall mortality in this period was 5.82%, compared to 3.28% in a similar period in 2019, (p &lt; 0.05). Postoperative mortality in COVID-19-positive patients was 19%. In conclusion, in the hospitals in Romania included in the survey, the overall mortality in the studied period was higher than in a similar period in 2019. In patients with COVID-19 positive, the recorded postoperative mortality was higher than overall mortality